Sepsis metabolic changes

Cachexia accompanies many diseases, which include sepsis, diabetes and AIDS, as weU as cancer (Chapter 16). The metabolic changes in cachexia are an extension of those presented above, but are more severe. An overview of the metabolic changes in cancer is given in Figure 21.24. The metabolic changes that occur in patients, after trauma and during cancer can be compared by reference to Table 21.5. 

Brune and Lapetina (1989) reported that NO could activate a platelet ADP-ribosyltransferase that resulted in the ribosylation of a 39 kDa protein. Subsequent work revealed that the protein was glyceraldehyde phosphate dehydrogenase (GAP-DH), and that ribosylation was associated with reduced GAP-DH activity (Dimmeler et al., 1992). In our collaboration with Molina et al., (1992), we have shown that GAP-DH activity is dramatically inhibited in C. parvum treated rats and that this action is associated with both a ribosylation and nitro-sylation of the enzyme. Such a marked inhibition of a glycolytic enzyme could explain some of the metabolic changes observed in the liver in sepsis. 

Plank LD, Hill GL. Sequential metabolic changes following induction of systemic inflammatory response in patients with severe sepsis or major blunt trauma. World J Surg 2000 24 630-638. 

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